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Dissertation
Relationships between impairments, three-dimensional kinematics, functional limitation, and disability in patients with subacromial impingement syndrome
Doctor of Philosophy (Ph.D.), Medical College of Pennsylvania and Hahnemann University
Dec 2001
DOI:
https://doi.org/10.17918/00006254
Abstract
Subacromial impingement syndrome is a multi-dimensional musculoskeletal disorder. This disorder can theoretically result from a variety of contributory factors, impacting a patient in a variety of ways. The medical management for subacromial impingement syndrome is commonly based on the theoretical disablement model. This model indicates that impairments lead to functional limitations then consequentially to disability. The purposes of this study were to examine: (1) measures of shoulder-specific functional limitation; (2) psychometric properties of the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES); and (3) relationships between impairment, functional limitation, and disability in patients with subacromial impingement syndrome. To examine the measures of self-report shoulder function, a MEDLINE literature search was performed to locate these scales. Eleven scales were selected for review, with methodological and practical criteria established to evaluate each scale. All scales met the minimal criteria, however not all scales were equal with regard to the criteria established for analysis. To examine the psychometric properties of the ASES, patients with shoulder dysfunctions (n = 63) completed the ASES, the University of Pennsylvania Shoulder Score (Penn), and the Short-form 36 (SF-36) during their initial evaluation, 24-72 hours later, and then after 3-4 weeks of physical therapy. The test re-test reliability, internal consistency, error, and responsiveness values were acceptable. Construct and discriminant validity was demonstrated. The ASES is a reliable, valid, and responsive outcome tool. To examine the relationships between the entities of the disablement model, patients with subacromial impingement syndrome (n = 48) completed three questionnaires; the SF-36, ASES, and Penn. Impairments of pain, range of motion, strength of the rotator cuff and scapular musculature, thoracic spine and forward shoulder posture, glenohumeral and scapulothoracic kinematics were assessed with various methods. Results demonstrated that there were multiple relationships between the measures. However, pain was the only impairment that demonstrated the ability to predict function limitation and disability. Relationships among the composite variables of impairments, functional limitation, and disability demonstrated moderate associations however, the data from this study suggested that the causal model of disablement described by Nagi is not the manner in which in which to characterize patients with subacromial impingement syndrome.
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Details
- Title
- Relationships between impairments, three-dimensional kinematics, functional limitation, and disability in patients with subacromial impingement syndrome
- Creators
- Lori A. Michener
- Contributors
- Philip W. McClure (Advisor) - Drexel University, Medical College of Pennsylvania and Hahnemann University (1993-1996, 1998-2002)
- Awarding Institution
- Medical College of Pennsylvania and Hahnemann University
- Degree Awarded
- Doctor of Philosophy (Ph.D.)
- Publisher
- Medical College of Pennsylvania and Hahnemann University; Philadelphia, Pennsylvania
- Number of pages
- xi, 175 pages
- Resource Type
- Dissertation
- Language
- English
- Academic Unit
- Medical College of Pennsylvania and Hahnemann University (1993-1996, 1998-2002); Rehabilitation Sciences/Physical Therapy [Historical]; College of Nursing and Health Professions (2000-2002)
- Other Identifier
- 991021888912204721